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This waiver is for our Mexico Missions Trip  to La Mision, Mexico.

Ventura Missionary Church Youth Mission Trip

(Acknowledgement of Risks and Assumption of Risk and Responsibility)

VMC and its authorized agents, employees, and representatives (referred to herein, collectively, as “VMC”) take precautions to provide proper organization, supervision, instruction, equipment, and supplies for participation in youth missions trips.  However, there are significant elements of risk in any mission trip, or sport, activity, or training associated with a mission trip, including but not limited to, travel, foreign countries, crime, host government, cooking, sports, weather or sun exposure, that may be carried out in the course of your child’ participation in the youth missions and the use of any related equipment.  Any or all of these or other activities may involve physical contact with others.

Youth Missions Program:  Students will be traveling to Door of Faith Orphanage in La Mission, Mexico from April 5-9, 2020. As part of the trip, students will be participating in such activities as: interacting and playing with the orphanage children, work projects (including but not limited to: painting, weeding, and general facility maintenance) providing a meal for the orphanage and staff, taking part in an organized soccer game with the orphanage kids, as well as distributing food and supplies in the surrounding communities (including Tijuana).

Acknowledgement of Risks:  I recognize the fact that there is inherent danger, foreseeable and  unforeseeable in these types of trips.  These risks may result in serious injury, loss of life, psychological trauma, emotional trauma, spiritual trauma, and include but are not limited to falls, weather exposure, accidents, being a victim of a crime (violent or otherwise) , sickness, being involved in a transportation accident as a driver, passenger, or pedestrian, being detained, abducted, kidnapped, and/or held hostage by criminals, terrorists, or insurgents, being arrested or detained by agents or agencies of the host government, being present at locations where civil unrest, insurgency, acts of terrorism or warfare occurs or erupts travel  and risks related to being in a foreign country and actions by foreign officials.


I realize that my child may suffer accidents, or illness, or be the victim of a crime. 


I realize that the nearest and preferred medical treatment facility is located in San Diego.  I realize that although all attempts will be made to seek medical treatment in San Diego, that might not be the case.


I have been given a copy of the informational and/or advisory documents, issued by government and/or private agencies; and I have read and considered this information. (available at venturamissionary.com/mexicomissions2019)

U.S. State Department - Mexico Travel alert

U.S. State Department - Mexico Travel Information


I have had sufficient opportunity to consider all of this information, and to collect and consider other information, and/or to assess the actual and potential dangers and risks associated with this trip.  My request of Ventura Missionary Church to participate in and/or allow my child to participate in this trip is made with the knowledge, understanding and voluntary acceptance of these actual and potential risks and dangers.


VMC will attempt to minimize all risks and monitor all participants.  Participants can lessen the inherent risk by carefully following all directions.


EXPRESS ASSUMPTION OF RISK AND RESPONSIBILITY:  In recognition of the various risks relating to the activities which my child will engage in, both foreseeable and unforeseeable, I confirm that my child is physically and mentally capable of participating in all activities and/or using equipment.  We understand the risks involved in a foreign missions trip.  My child’s participation is voluntary and I will assume all risks and full responsibility, on behalf of all parties including myself, my child, and my child’s heirs and assigns, for (a) any and all losses incurred as a direct or indirect result of personal injury, accidents, illness, or crime, and (b) any and all damage to or loss of personal property arising out of relating to, or in connection with the Youth Mission’s trip.


WAIVER AND RELEASE FROM LIABILITY:  ON BEHALF OF MY CHILD, MYSELF, MY CHILDS OTHER GUARDIANS, AND MY CHILD’S HEIRS AND ASSIGNS, I HEREBY ASSUME ALL RISKS AND WAIVE, RELEASE AND FOREVER DISCHARGE VMC FROM ANY AND ALL LIABILITY, ACTIONS, CAUSES OF ACTION AND DAMAGES OF WHATEVER KIND WHATSOEVER, INCLUDING, WITHOUT LIMITATION, GENERAL, SPECIAL, COMPENSATORY AND PUNITIVE DAMAGES, FOR PERSONAL INJURY, PROPERTY DAMAGE, CRIME, NEGLIGENCE OR WORNGFUL DEATH ARISING OUT OF, RELATING TO OR IN CONNECTION WITH YOUTH MEXICO MISSIONS TRIP.

Medical Authorization: I hereby authorize any medical treatment deemed necessary in the event of any injury or sickness while my child is participating in the activity.  I either have appropriate insurance, or in its absence, agree to pay all costs of rescue and or medical services as may be incurred on my child’s behalf.  I agree to hold VMC harmless for any and all costs or liabilities so incurred.


VMC Actions:  I realize that VMC may find it necessary to terminate the Youth Mexico Missions Trip, whether due to forces of nature, government, crime, medical necessities, problems in the group, or other reasons that VMC, in its discretion, deems prudent.  I also realize that VMC may refuse or terminate the participation of any person, in its sole discretion, judges to be incapable of meeting the requirements of participating in the Youth Missions Trip.  I accept VMC’s right to take such action with respect to my child and other participants.


I HAVE CAREFULLY READ AND UNDERSTAND THIS ACKNOWLEDGEMENT OF RISKS, ASSUMPTION OF RISK AND RESPONSIBILITY AND WAIVER AND RELEASE FROM LIABILITY AND FULLY UNDERSTAND ITS CONTENTS.  I AM AWARE THAT THIS IS AN ASSUMPTION OF RISK AND RELEASE FROM LIABILITY THAT INVOLVES THE WAIVER OF CERTAIN
LEGAL RIGHTS AND I SIGN IT OF MY OWN FREE WILL.

 

 

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
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Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Insurance

Insurance Carrier*

Insurance Policy Number*
Medical Information
Does the participant have a chronic or recurring illness or medical condition? (i.e. seizures, ADD, depression etc.) please give details in area given for explanation*
No
Yes
Has the participant been hospitalized recently? please give details in area given for explanation*
No
Yes
Does the participant have any allergies to medications? please give details of medication and reaction in area given for explanation*
No
Yes
Does the participant have up to date vaccinations (as required by school district)?*
No
Yes

Date of last tetanus shot
Does the participant have any allergies? please list all items allergic to and symptom(s) of allergy attack in area given for explanation*
No
Yes
Does the participant have any physical/mental/psychological condition requiring special treatment? (If yes, please explain in explanation section)*
No
Yes
Does the participant have insulin dependent diabetes?*
No
Yes
Does the participant have activity restrictions/limitations?*
No
Yes
Does the camper have activity restrictions/limitations?Click to customize question*
No
Yes
Does the participant have any dietary restrictions?*
No
Yes

Please put all answers requiring explanation here.

Please list all medications taken by camper (including dosage, frequency and type of illness being treated)
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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